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Home My WebLink AboutPermit Building 1985-02-21CTION LINE 769 CITY OF SPRiNGFIELD COHBI I1ATION APPLICAIION/PERMIT 26-3753 Job Address Legal Description EIIERGY SOURCES Hea t l,later Heater Sq. Ftq l.la i n 5q. Ftg. Access._ Sq. Ftg. Other_ _l'lew_Ad d_A I te r_Re p . _Fence_Demo Change/Use 0ther )rft h, / 10uA -l 'U"1.SI)O.tPOwner Phone e ng el,lith Attached Ga construcliof, Lender J Addre s s Phone \\ DES I GN TEAI.I name address I ics. no.exD I res ohone no. Pri ma ry Structura l El ectri cal Hechani cal CONTR,ACTORS name addres s Iicq- no-ohone no. Pl umbi nq E I ectri ca I I'techa ni ca I PLUNBI NG ELECTR I CAL MECHAN I CAL FFF CHARGF NN FFF CHARGF NO FFF CHARGF Each single fixture Res idence of sQ. FT. furnace/burner to BTU' S Relocated building (new fix. additional) New circuits alts or extensions Floor furnace and vent S.F. Residence ( l bath)SERV I CES Recessed wal I Sntap hpattrr and vpnt Duplex (l bath) each Addi ti onal bath Temporary Construct i on Apol iance vent seoa ra te llater servi ce Chang resi d e in existing ence Stationary evap cool er Sewer multifamily, conrn 0r Indrrstrial Vent fan with sinole duct Storm Sewer 0f amps,Vent systern apart from heatinq or A.C. COMI.I./IND. FEEDERS Mechani cal exhaust hood and duct Instal I /al ter/rel ocate diqtrih fcpdprs l'lood stove/heater 0f amps ISSUANCE OF PFRI1IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAN shall not be valiC r REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernituntil the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed apnlication for oermit, and do hereb.y certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the Cityof Springfield and the Laws of the State of 0regon oertaining to the work described herein, and that NC 0CCUPAI'ICY will be madeof any structure without the permission of the Building Division. I further certify that my registration vrith the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in comcliance with 0l?S 701.055 will be used on this nroject. IlAl.lE(please print)S IGNATURE {?rE 2-Zt-F{ Zone___TyDe/ Const Uni ts Ftg. l'lain x Value FireZoneBedrooms0ccyLoadSq.Ftg.AccessxValue- Flood Plain Stories Group Sq. FtS. 0ther___x Val ue TOTAL VALUATION BUILDING PERI'IIT Charges and Surcharges PIan Ck. Corm/Ind 65%/8ldo Per Fee rge opmmt Plan Ck. Res 30%/Bl do Per Fee PLUI,|B ING PERMI T Charges and Surcha rges Fence 06mo ELECTRICAL PERt,IIT Charges and Surcha rges Sidewal k A/C Paving Total Comb. Permit IlECHANICAL PERMIT Charges and Surc harges Curb Cut TOTAL @ COMBINATION APPLICATION/PERMIT ( CAP) I. Applicant to furnishA. Job AddressB. Legal Description l. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, Znd Addition toS[iTngfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION 1 9lr gas &-s\ -€'3 E. Squa ft(,1. example- 1?50 sq. foot house, 500 sq. foot garage2. example- if hew project, check-new - if additio;,check add, etc.F. Building permit jnformation: l. example - construct single family house with anattached garage ?. example - remodel existing garage into fam.ily roomJ. example - convert single family residence into , restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the appl'icant need fill-in only the No. Boxes adjaientto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Etectrical Schedulesare available at the Building Division1. To conserve space on the permit form the scheduleshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF I,IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The generai contractor ii not authorizedto sign the electricai labelApplicant to sign and date l,lhenever possible, the initial application will be used asa-worksheet only. Hhere possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for hissi gnature. Fees and Charges Plan check fees are due and payable at the t.ime of theapplication, and no plans will be processed unt.il thesefees are paid. Ail other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY N0 II. III. IV. ; v Permit Cler PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name s1 g nature date 2.